Univariate Statistical Analysis Research Articles

Factors Associated with Alternate Level of Care Status Designation: a Case-Control Study and Model to Optimize Care Trajectories.

As health-care demand is growing, our health-care system will require the optimization of the care trajectories. Patients with an alternate level of care (ALC) status could be a target for flow optimization. We aimed to characterize ALC patients and risk factors for ALC status, and to propose an integrated model to analyze the trajectory of ALC patients and discuss solutions to reduce their burden. A case-control design was used to compare 60 ALC and 60 non-ALC patients admitted to the geriatric unit of the Centre hospitalier de l'Université de Montréal in 2021, collecting medical and sociodemographic data. Based on our model, univariate statistical analyses were computed to compare groups and identify risk factors for ALC status. ALC patients were less independent (22% performed five to six activities of daily living vs. 43%, p = .03). Both groups were comparable in terms of mobility and neurocognitive disorders. ALC patients were more likely to receive a new diagnosis of a neurocognitive disorder or new behavioural or psychological symptoms (37% vs. 15%, p = .008). Up to 25% of ALC patients were admitted despite presenting no active medical condition (vs. 3% of non-ALC patients, p = .002). The optimization of the care trajectory of ALC patients is mainly based on pre-hospital and post-hospital factors. A proportion of ALC admissions might be avoidable with additional investment in home care resources and relocation procedures. Fluidity of ALC trajectory may benefit from improved orientation at discharge procedures. Full optimization of ALC trajectories requires a systemic understanding of the health-care system.

Identification of genes related to PD-L1 expression in non-small cell lung cancer (NSCLC) tumor samples by GFPrint, a machine learning framework (MLF).

e13600 Background: The advent of drugs targeting the PD-1/PD-L1 axis has revolutionized NSCLC treatment. Although promising, individual responses to these therapies can vary among individuals, and research is ongoing to better understand the mechanisms involved in PD1/PD-L1 expression to optimize treatment protocols, and identify which patients are most likely to benefit from these therapies. In this study, Genetic Fingerprint (GFPrint), a MLF, was employed to identify mutations in genes linked to PD-L1 expression in NSCLC tumor samples. Methods: Whole exome sequencing (WES) was run on samples from biopsies of 46 NSCLC patients (histologic subtypes: squamous-cell carcinoma and adenocarcinoma). WES data were encoded using GFPrint, a MLF that generates virtual representations of the tumor exomes in a latent space (LS) defined by the genetic features of the samples. Clusters of patients were identified in such LS based on the genetic similarities of their tumors. Statistical univariate analysis was run to analyze differences in the distribution among both clusters of clinical (age, smoking, and metastatic status) and pathological (histotype and PD-L1 expression) features. The mutational burden (MB) of each cluster was also examined by pathway enrichment analysis (PEA). Results: Two main clusters were identified, C0 (n=16) and C1 (n=17), with 13 unassigned patients. Main differences between clusters were related to histology and PD-L1 expression. C0 included significantly less patients with adenocarcinoma (10/16; 62.5%) compared to CL1 (17/17; 100%) (p-value=.01). In addition, C0 presented more patients expressing PD-L1 (9/16; 56.2%) compared to C1 (3/17; 17.6%) (p-value=.04). Of interest, PD-L1 positivity was significantly higher (p value=.03) in adenocarcinomas of C0 patients (6/10; 60.0%) than those of C1 (3/17; 17.6%). Moreover, C0 adenocarcinomas presented higher levels of PD-L1 expression (6.3+/-9.7 %) than those of C1 (2.3+/-7.5 %) (p value=.06). MB analysis revealed that 1,357 genes were mutated exclusively in C0 patients, and PEA allowed the identification of 3 enriched cancer-related KEGG pathways: HIF-1 signaling, Ca2+ signaling and actin cytoskeleton. Selection of non-silent mutations in these pathways enabled the identification of 10 genes, mostly included in the HIF-1 signaling pathway, with previous data suggesting their involvement in PD-L1 regulation and expression: PIK3R1, HK1, NOS2, NRAS, BRAF, ITGA1, ITGA9, EGLN1, EGLN2 and AKT1, being the first 6 the only ones found in adenocarcinomas. Conclusions: The identified genes deserve further studies to validate them as possible targets of pharmacological intervention concomitant to PD-1/PD-L1 blockade, and also as potential biomarkers for patients’ selection to improve the efficiency of immunotherapy in NSCLC treatment.

Urinary metabolome of infants with colic treated with Lactobacillus reuteri DSM 17938: a pilot randomized trial.

Lactobacillus reuteri DSM 17938 is the only probiotic recommended for treatment of colicky infants, but its mechanism of action is not clear. The study aim was to examine urinary metabolomic fingerprint of colicky breastfed infants before and after 1 month of orally administered Lactobacillus reuteri DSM 17938 or placebo. This randomized, blinded, placebo-controlled clinical trial was carried out with a well-documented probiotic. Thirty-two infants were enrolled, 16 in the probiotic group and 16 in the placebo group. Urine samples were collected from each subject before starting supplementation and at the end of the study period. Metabolomic profiles were obtained using a gas chromatography/mass spectrometry instrument. Subsequently, to compare groups before and after probiotic supplementation, univariate and multivariate statistical analysis were performed. In the L. reuteri treated group all metabolites for all class of nutrients (sugars, amino acids, carboxylic acids) resulted more abundant after the study period. The comparison with a control group (placebo treated), confirmed this effect on urines. The metabolomic analysis of urine samples from infants treated with L. reuteri DSM 17938 allowed to detect some interesting features related to the effect of this treatment on urinary metabolome. To validate the results, a test on a larger cohort is required.

Linking the companion diagnostic function of cancer genome profiling to therapy: Investigation of TMB-high predictors.

e13033 Background: Based on the companion diagnostic function of the Comprehensive Cancer Genome Profiling (CGP) test in Japan, pembrolizumab is the standard treatment for patients with Tumor Mutational Burden (TMB)-high (H) solid tumors. In this report, we attempted to extract predictive factors of TMB-H from CGP test results. Methods: We carried out a retrospective cohort study of 42 patients with malignant breast tumors (excluding circulating tumor DNA in the blood) who underwent CGP testing between June 1, 2019, and November 30, 2023, at our hospital and affiliated institutions. We analyzed the association between clinicopathological factors, the number of analyzed cancer-related gene mutations (SNV, InDel), and TMB-H using univariate and multivariate statistical analysis. Results: Of the 42 cases (27 positive and 15 negative for estrogen receptor (ER), respectively), seven (16.7%) were TMB-H. Samples significantly associated with TMB-H according to univariate analysis were submitted as pathology specimens (non-primary (16.7%) vs. primary (0%), p = 0.011), ER (positive (16.7%) vs. negative (0%), p = 0.044), letrozole (LET) (yes (11.9%) vs. no (4.8%), p = 0.008), and previous treatment (after 6th line (14.3%) vs. before (2.4%), p = 0.041). Multivariate analysis showed that LET had a significant effect on TMB-H in Aromatase inhibitor agents (LET + Anastrozole + Exemestane) (LET: OR, 19.9; 95% CI, 2.2–183.5; p = 0.008) and the number of cancer-related gene mutations (PIK3CA+TP53) were significantly affected (PIK3CA: OR, 3.8; 95% CI, 1.1–13.2; p = 0.032. TP53: OR, 0.08; 95% CI, 0.01–0.66; p = 0.015). Single regression analysis showed a significant association between the number of PIK3CA mutations and LET. (β, 0.31; SE, 0.11; p = 0.008). Conclusions: ER positivity, history of LET use, prior therapy after the 6th line, and submission of pathology specimens from non-primary tumors to CGP testing are predictive factors for TMB-H. In multivariate analysis, the history of LET use and the number of PIK3CA mutations were significantly associated with TMB-H. Research shows that PIK3CA mutations are most frequent in patients who have undergone preoperative endocrine therapy with LET (Breast Cancer Res Treat. 2020 Nov;184(1):123–133.), suggesting that an increased number of PIK3CA mutations due to LET contributed to TMB-H. Although immune checkpoint inhibitors (ICIs) are not indicated for ER-positive breast cancer, TMB-H may be a predictor of ICI efficacy in such cases. The limitations of our research were the small sample size, and the study population only included Japanese. For the next steps needed to continue in this research, clinical trials should take place to test whether TMB-H is a predictor of ICIs in a wider population of ER-positive breast cancer.

Acquired Immunity and Effects of SARS-CoV-2 Vaccination in Healthcare Work-ers and Nursing Students. Post-Booster Follow-Up

Introduction: Discussions on COVID-19 vaccine efficacy and the duration of immunity are relevant to health policy intervention. Aims: To assess adherence to SARS-CoV-2 vaccination in healthcare workers (HCWs) and nursing students (NS). To determine IgG levels after booster doses and to identify effects of vaccination. Methods: Observational followup study on the impact of COVID-19 and vaccine efficacy in 2021 and 2022. The study population comprised HCWs and NS from Albacete (Spain). The sample size was 179 HCWs and 120 NS. Data was gathered using a self-administered questionnaire and venous blood samples 6 months after full vaccination and 6 months after the booster dose, in which IgG levels against SARS-CoV2 were measured. Univariate statistical analyses and bivariate analyses were performed using SPSS (28.0). The project was ap-proved by the Ethics and Clinical Research Committee of Albacete. Results: A total of 229 individuals completed the questionnaires and participated in the initial analyses (148 HCWs and 81 NSs). Adherence to the SARS-CoV-2 vaccination regimen was high (100% in NS and 97% in HCWs). Booster doses were received by 94% of the sample. Homologous vaccines were received by 29% and het-erologous vaccines by 71%. IgG levels: 6 months after full vaccination, seropositivity was 100% and mean IgG levels were 3,017.2 AU/ml in HCWs and 2,484.62 AU/ml in NS (p<0.001). At 6 months after the booster dose the mean IgG levels were 25,789.34 AU/ml in PS and 17,155.07 AU/ml in NS (p<0.001). Adverse effects of the vaccines were mild and local, with some present in a high proportion of those vaccinated. Conclusions: After vaccination, antibody levels were positive at 6 months and increase considerably after the booster dose, remaining high 6 months later. No serious side effects were reported, but a high incidence of mild effects, both general and local, was observed.

UHPLC-HRMS-based Multiomics to Explore the Potential Mechanisms and Biomarkers for Colorectal Cancer

BackgroundUnderstanding the metabolic changes in colorectal cancer (CRC) and exploring potential diagnostic biomarkers is crucial for elucidating its pathogenesis and reducing mortality. Cancer cells are typically derived from cancer tissues and can be easily obtained and cultured. Systematic studies on CRC cells at different stages are still lacking. Additionally, there is a need to validate our previous findings from human serum.MethodsUltrahigh-performance liquid chromatography tandem high-resolution mass spectrometry (UHPLC-HRMS)-based metabolomics and lipidomics were employed to comprehensively measure metabolites and lipids in CRC cells at four different stages and serum samples from normal control (NR) and CRC subjects. Univariate and multivariate statistical analyses were applied to select the differential metabolites and lipids between groups. Biomarkers with good diagnostic efficacy for CRC that existed in both cells and serum were screened by the receiver operating characteristic curve (ROC) analysis. Furthermore, potential biomarkers were validated using metabolite standards.ResultsMetabolite and lipid profiles differed significantly among CRC cells at stages A, B, C, and D. Dysregulation of glycerophospholipid (GPL), fatty acid (FA), and amino acid (AA) metabolism played a crucial role in the CRC progression, particularly GPL metabolism dominated by phosphatidylcholine (PC). A total of 46 differential metabolites and 29 differential lipids common to the four stages of CRC cells were discovered. Eight metabolites showed the same trends in CRC cells and serum from CRC patients compared to the control groups. Among them, palmitoylcarnitine and sphingosine could serve as potential biomarkers with the values of area under the curve (AUC) more than 0.80 in the serum and cells. Their panel exhibited excellent performance in discriminating CRC cells at different stages from normal cells (AUC = 1.00).ConclusionsTo our knowledge, this is the first research to attempt to validate the results of metabolism studies of serum from CRC patients using cell models. The metabolic disorders of PC, FA, and AA were closely related to the tumorigenesis of CRC, with PC being the more critical factor. The panel composed of palmitoylcarnitine and sphingosine may act as a potential biomarker for the diagnosis of CRC, aiding in its prevention.

Small Hemothoraces Not Drained on Admission: Initial Volume Predicts Need for Intervention.

Unlike large hemothoraces (HTX), small HTX after blunt trauma may be observed without drainage. We aimed to study if there were risk factors that would predict the need for intervention in initially observed small HTX. A retrospective review of patients with blunt traumatic HTX from 2016 to 2022 was performed. Patients with small HTX (pleural fluid volume <400mL on admission chest computerized tomography [CT]) were included. Patients were considered as being "initially observed" if there was no intervention for the HTX within 48hours after admission. Primary outcome was any HTX-related intervention (open, thoracoscopic or percutaneous procedures) occurring after 48hours and up to 6months after injury. Univariable and multivariable statistical analyses were employed. A P-value of <.05 was considered significant. Of 335 patients with HTX, 188 (59.6%) met inclusion criteria. Median (interquartile range) HTX volume was 90 (36-134)ml. One hundred and twenty-seven (68%) were initially observed. Of these, 31 (24%) had the primary outcome. These patients had a larger HTX volume (median, 129 vs 68mL, P = .0001), and number of rib fractures (median, 7 vs 4, P = .0002) compared to those without the primary outcome. Chest-related readmission occurred in 8 (6%) with a median of 20days from injury. Of these, 7 required an HTX-related intervention. Logistic regression analysis found that both the number of rib fractures and HTX volume independently predicted the primary outcome. For small HTX initially observed, number of rib fractures and initial volume predicted delayed HTX-related intervention.

#1836 Post-transplant evolution of kidney grafts from expanded criteria donors with diabetes

Abstract Background and Aims The increase in the number of potential kidney transplant (KT) recipients has led to efforts to increase the donor pool, including organs from expanded criteria donors (ECD) with diabetes mellitus (DM). However, doubts persist about their viability, especially with DM donors. Our aim is to analyze the post-transplant evolution of KT patients who have received kidney grafts from ECD with or without DM. Method Retrospective observational study of KT who received ECD kidney graft in our center between January 2014 and November 2023. We divided KT patients into two groups based on donor DM; ECD with DM and ECD without DM. We analyzed baseline characteristics and post-KT evolution. Univariate and multivariate statistical analysis was performed using Cox regression (SPSS Statistics 29.0). Results During the study period, 161 patients received grafts from ECD at our center. Pre-implant biopsies were performed on all grafts, with 15 discarded due to high histological score. Of these, 13 (86%) were diabetic donors (p &amp;lt; 0.001). The mean age of donors was 66 years, and that of recipients was 61. Forty-three (26%) KT recipients had a diabetic donor. Clinical characteristics of patients are reflected in Table 1. Conclusion Donors with DM showed adequate survival in our experience, similar to that of other ECD. This may be due to a more stringent pre-transplant clinical selection or pre-KT histological assessment. The development of new techniques is necessary to more precisely asses the viability of these grafts pre-KT, allowing for an increased utilization.

A study protocol to characterise pathophysiological and molecular markers of rheumatic heart disease and degenerative aortic stenosis using multiparametric cardiovascular imaging and multiomics techniques.

Rheumatic heart disease (RHD), degenerative aortic stenosis (AS), and congenital valve diseases are prevalent in sub-Saharan Africa. Many knowledge gaps remain in understanding disease mechanisms, stratifying phenotypes, and prognostication. Therefore, we aimed to characterise patients through clinical profiling, imaging, histology, and molecular biomarkers to improve our understanding of the pathophysiology, diagnosis, and prognosis of RHD and AS. In this cross-sectional, case-controlled study, we plan to recruit RHD and AS patients and compare them to matched controls. Living participants will undergo clinical assessment, echocardiography, CMR and blood sampling for circulatory biomarker analyses. Tissue samples will be obtained from patients undergoing valve replacement, while healthy tissues will be obtained from cadavers. Immunohistology, proteomics, metabolomics, and transcriptome analyses will be used to analyse circulatory- and tissue-specific biomarkers. Univariate and multivariate statistical analyses will be used for hypothesis testing and identification of important biomarkers. In summary, this study aims to delineate the pathophysiology of RHD and degenerative AS using multiparametric CMR imaging. In addition to discover novel biomarkers and explore the pathomechanisms associated with RHD and AS through high-throughput profiling of the tissue and blood proteome and metabolome and provide a proof of concept of the suitability of using cadaveric tissues as controls for cardiovascular disease studies.

Spatio-temporal variation of mesozooplankton in the northern coastal waters of Bay of Bengal

Mesozooplankton (MSP) are significant primary and secondary consumers in aquatic ecosystems that influence biogeochemical cycles and are considered important bioindicators of ecosystem functioning. Data on the spatio-temporal variability of the MSP population from the estuarine and coastal waters of northwestern Bay of Bengal (BoB) is scarce. The present study is the first detailed investigation on the spatio-temporal dynamics of MSP along the estuarine and coastal waters of northwestern BoB from two contrasting seasons over a period of three years based on univariate and multivariate statistical analyses. The crucial drivers for spatio-temporal variability in the MSP community were water temperature, salinity, dissolved oxygen (DO) concentration, nutrient (nitrate, phosphate, silicate) concentrations, and Chlorophyll (Chl) a concentration. The highest mean MSP abundance was obtained during summer monsoon (SM). The results of this study state that there is a significant seasonal difference in the hydrographical parameters that change the community dynamics of MSP inhabiting the estuarine and coastal waters of BoB. The MSP species assemblages during winter monsoon (WM) were governed by high salinity and DO levels while those during SM were associated with high water temperature, nutrients, and Chl a concentration. A clear seasonal shift from the gelatinous community in WM to the crustacean community in SM was documented. A total of 172 MSP species were identified during WM, and 200 MSP species during SM, with 37 species being exclusively detected during WM and 65 species being exclusively recorded during SM. The most abundant species during WM were Chrysaora caliparea, Cyanea nozakii, Sagitta bipunctata, Pleurobrachia pileus, and Acromitus flagellatus to name a few and those during SM consisted of Undinula vulgaris, Acartia (Odontacartia) spinicauda, Oithona simplex, Oithona similis, and Oncaea venusta. Copepoda was the most dominant taxa during all sampling seasons, while ichthyoplankton and meroplankton fauna were low during WM and comparatively higher during SM, indicating the top-down control of their population by gelatinous taxa. Biodiversity indices reflected well to excellent diversity patterns of MSP. In the current scenario of global warming and climate change, our research highlights the need for comprehensive long-term monitoring of estuarine and coastal waters of western BoB, which harbour a rich marine faunal diversity, to identify the bioindicators of seasonal variability among major MSP groups.

Mechanism of Jinteng Qingbi granules in the treatment of rheumatoid arthritis using metabolomics analysis.

This study investigated the differential metabolites after rheumatoid arthritis (RA) rats were treated with Jinteng Qingbi granules. Collagen-induced arthritis rats were divided into three groups, namely normal group, model group, and Jinteng Qingbi granules group. Serum compounds were identified, annotated, and classified using metabolomics to explain the physicochemical properties and biological functions. The metabolites were screened using univariate and multivariate statistical analyses. There were differences in serum metabolites between RA and normal rats; Jinteng Qingbi granules improved RA and recovered the metabolite levels to normal. Compared to the normal group, 51 differential ions were screened, and 108 ions were changed in the Jinteng Qingbi granules group compared to the RA model. Eight metabolites were upregulated in the RA model group compared to the normal group, whereas 10 metabolites were downregulated. Treatment with Jinteng Qingbi granules increased the levels of 12 metabolites such as cinnamate and decreased the levels of 16 metabolites such as allamandin in the RA model. Differential ion enrichment was mainly related to the histidine metabolic pathway in amino acid metabolism. Jinteng Qingbi granules resulted in improvements in the RA model, which were mainly associated with lipids and lipid-like molecules, organic acids, and derivatives, providing a new possibility and basis for screening biomarkers for the diagnosis and treatment of RA.

Investigating the discriminatory potential of urinary DNA adductomics in smokeless tobacco-treated rats and head-neck cancer patients

The genotoxicity of smokeless tobacco (ST) remains an essential public health issue. We conducted a comprehensive study of rats exposed to ST and head and neck cancer patients to elucidate the DNA adduct profiles. ST exposure assessment used alkaloids and tobacco-specific nitrosamines in rat urine. High ST doses led to significantly elevated nicotine, cotinine, N-nitrosonornicotine (NNN), and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) levels, indicating substantial exposure. DNA adductomics identified 17 significant DNA adducts using a neutral loss scan in liquid chromatography-mass spectrometry in rat urine samples upon ST exposure, highlighting the intricate landscape of DNA modifications associated with ST using univariate and multivariate statistical analyses. LC-ESI-QTOF-MS/MS analysis and accurate mass measurements of DNA adducts unveiled specific adducts upregulated in response to ST exposure, particularly those associated with methylation and NNK release. Intriguing correlations emerged between DNA adducts and alkaloids-TSNA in ST-exposed rat urine. Nicotine correlated positively with N2-paraldol-dG and O2/O4-[4-(3-Pyridyl)-4-oxobut-1-yl] thymidine in high-dose rats. NNK correlated with 6O-methylgaunine, while NNN correlated with 6-hydroxy-1-N2-propanodeoxyguanosine and 7-methylguanine. With this aim, we also applied analysis to human samples, where we observed specific DNA adducts for ST users, controls, and subjects with HNC. Two-way ANOVA showed that ST users and cancer patients had higher DNA adduct levels in human urine, which aids cancer risk assessment, early detection, and environmental exposure evaluation. This comprehensive study explores DNA adducts caused by ST exposure across rats and head and neck cancer patients, illuminating genotoxic mechanisms and health risks and providing valuable insights for future preventive and therapeutic strategies.

Exploring the Causes of Low Literacy Rate: A Case Study of District Lasbela, Balochistan

The aim of this study is to examine the basic causes and consequences of the low literacy rate in the district of Lasbela Balochistan, Pakistan. Education plays a predominant role and has a cross cutting influence on all features of human life. It is an energetic speculation for economic and human improvement. The most fundamental and important need for each individual and for society at large is education. The purpose of this study was to ascertain the literacy rate in district Lasbela using descriptive research methodology. A sample of 200 respondents was selected to collect data form nine tehsils of Lasbela district with help of self-administered close ended questionnaire. Mixed methodology was adopted to scrutinize research problems. The study made use of univariate and bivariate statistical analysis methods, data visualization, and the chi-square test of independence. Software called SPSS (Statistical Package for Social Sciences) is also utilized for statistical applications and data analysis. The result of the study indicates that low earnings of family (poverty), poor management in education and dropout of students have a moderate and statistically significant effect on the illiteracy rate respectively. For policy recommendations some constructive measures have been suggested such as induction of qualified and skills teachers, best management system in educational sector, opportunities for local people in jobs and free and feasible education for the students at all levels. Keywords: , , ,

Abuse in Chilean Trans and Non-Binary Health Care: Results from a Nationwide Survey

Abuse in health care (AHC) is an emerging concept used to describe healthcare practices and conduct that health services users find belittling and degrading. Such experiences, whose causes are not always voluntary but systematic and structural, have been described as one of the main barriers to the trans and non-binary population’s access to health care. To study this problem in Chile, the country’s first trans and non-binary health survey was conducted between January 2021 and June 2022 with the participation of 1116 people. Univariate statistical analyses were performed to calculate the frequencies (f) and percentages (%) of the different forms of AHC reported. Chi-squared tests (p &lt; 0.01) and the Pearson correlation coefficients (r &gt; 0.10) were used to identify statistically significant correlations between experiences of AHC, the health personnel reportedly involved, and participants’ responses to these experiences. About 84% of the participants who replied to questions on this subject said that they had experienced some form of AHC. The most frequently reported were inappropriate use of pronouns (65.9%) and stereotypical comments about genders (48.3%). These events occurred mostly in encounters with secretaries and receptionists, followed by psychologists and nurses. The most frequent response of participants to these situations was to change the medical staff responsible for their care, followed by ceasing to seek professional attention. A mainstreamed relational gender perspective is required to address the complexity of this problem.

Dynamics of outcomes of thoracoscopic microdiscectomy

Object of the study. Thoracoscopic microdiscectomy (TM) is used for surgical treatment of thoracic disc herniations (TDH). The purpose of this study was to analyze the factors influencing the dynamics of outcomes in the early and late postoperative period Materials and methods/ The study had a retrospective, single-center, observational cohort design. The series included all patients without exception who underwent TM from January 2018 to December 2022. Outcomes were assessed according to the Macnab scale adapted for the thoracic spine. Postoperative complications were classified according to the Clavien-Dindo Classification. Statistical univariate analysis of the data was carried out using the Fisher»s method and the Mann-Whitney U test. Multivariate analysis was performed using multiple linear regression with stepwise elimination. Results/ A total of 36 patients were operated on using the TM technique. These included 22 (61 %) women and 14 (39 %) men. The median age was 45±15 years. Early outcomes were assessed 2 months after the patients» surgery. The median duration of long-term outcomes was 22±12 months. The statistical analysis of early outcomes revealed a connection between the localization of a disc herniation in the lower thoracic spine (Th8 — Th12) with simultaneous surgery at two levels and less favorable outcomes. The analysis of long-term outcomes showed that the only prognostic factor was the patient»s condition when assessing the early outcome. Thus, complete recovery was registered at the first control in 13 out of 15 (86 %) patients and at the last control in 13 out of 16 (81 %) patients (p &lt;0.001). Conclusions. The analysis of early and long-term outcomes made it possible to identify factors that determine the dynamics of recovery after thoracoscopic microdiscectomy. The data obtained can be used in planning postoperative management of this group of patients.

An untargeted analytical workflow based on Kendrick mass defect filtering reveals dysregulations in acylcarnitines in prostate cancer tissue

BackgroundMetabolomics is nowadays considered one the most powerful analytical for the discovery of metabolic dysregulations associated with the insurgence of cancer, given the reprogramming of the cell metabolism to meet the bioenergetic and biosynthetic demands of the malignant cell. Notwithstanding, several challenges still exist regarding quality control, method standardization, data processing, and compound identification. Therefore, there is a need for effective and straightforward approaches for the untargeted analysis of structurally related classes of compounds, such as acylcarnitines, that have been widely investigated in prostate cancer research for their role in energy metabolism and transport and β-oxidation of fatty acids. ResultsIn the present study, an innovative analytical platform was developed for the straightforward albeit comprehensive characterization of acylcarnitines based on high-resolution mass spectrometry, Kendrick mass defect filtering, and confirmation by prediction of their retention time in reversed-phase chromatography. In particular, a customized data processing workflow was set up on Compound Discoverer software to enable the Kendrick mass defect filtering, which allowed filtering out more than 90 % of the initial features resulting from the processing of 25 tumoral and adjacent non-malignant prostate tissues collected from patients undergoing radical prostatectomy. Later, a partial least square–discriminant analysis model validated by repeated double cross-validation was built on the dataset of 74 annotated acylcarnitines, with classification rates higher than 93 % for both groups, and univariate statistical analysis helped elucidate the individual role of the annotated metabolites. SignificanceHydroxylation of short- and medium-chain minor acylcarnitines appeared to be a significant variable in describing tissue differences, suggesting the hypothesis that the neoplastic growth is linked to oxidation phenomena on selected metabolites and reinforcing the need for effective methods for the annotation of minor metabolites.

Robust Analysis of the Influencing Factors for Hospitalization Costs of Senile Cataracts Patients in Chengdu Considering Different Types of Insurance

Chengdu is one of the earliest pilot cities for urban-rural basic medical insurance integration in China. This study aimed to analyze the influencing factors of hospitalization costs of senile cataract in a tertiary hospital in Chengdu by robust method, especially considering the influence of medical insurance type. A total of 1310 discharged patients from a tertiary hospital from January 2020 to June 2021 who were mainly diagnosed with senile cataracts were selected as the research subjects. Kruskal-Wallis H test and Spearman correlation analysis are used to conduct univariate statistical analysis. The robust multivariate linear regression model and a semi-parametric multivariate regression model are established to obtain the influencing factors for their hospitalization costs. The robust multivariate regression model results show that reimbursement ratio, number of surgeries, type of medical insurance, hospitalization days, number of additional diagnoses and material proportion have significant correlations with the response variable, i.e. total hospitalization costs of the senile cataract patients. In the robust multivariate regression analysis, the type of insurance is significantly associated with the hospitalization costs. Fixing other variables, the hospitalization costs of patients with UEBMI insurance were 7.6% higher than those with URRBMI insurance. Generalized additive model (GAM) can express the nonlinear relationship between explanatory variables and response variable. Because of the nonlinear part of the GAM, the interpretation and description of the model can provide more knowledge than the linear models. In the GAM model, the type of insurance is also significantly related to the total costs. According to the regression effects of reimbursement ratio, number of surgeries, type of medical insurance, hospitalization days, number of additional diagnoses and material proportion on total costs, the paper aims to provide some references for promoting the reform of the local medical system and improving the eye health status and quality of life of middle-aged and elderly groups.

Albumin-to-alkaline phosphatase ratio may be a better predictor of survival than sclerostin, dickkopf-1, osteopontin, osteoprotegerin and osteocalcin

ObjectivesThe value of biochemical markers of bone turnover (BTMs) in predicting survival and disease remains unclear. In a prospective study we evaluated the novel biomarkers for bone turnover sclerostin, dickkopf-1 (DKK-1), osteopontin (OPN), osteoprotegerin (OPG) and osteocalcin (OC), as well as a traditional biomarker, alkaline phosphatase (ALP) in relation to risk of mortality, cardiovascular events and fractures. Participantsand Methods:Routine blood tests and serum BTMs, including ALP, were analyzed in patients with hip fracture n = 97, stroke n = 71 and healthy volunteers n = 83 (mean age 86, 83 and 77, respectively), followed for 7 years. Hazard Ratios (HR) were calculated for mortality, cardiovascular events and fractures in relation to these biomarkers. After adding the albumin-to-ALP ratio (AAPR) a post hoc analysis was performed. Results120 participants died during the study. In the entire group of patients and volunteers (n = 251) higher AAPR (HR 0.28, 95 % CI 0.14–0.59, p < 0.001) was associated with decreased mortality. OPN and OPG were associated with mortality risk only in the univariate statistical analysis. HR for high AAPR in relation to new cardiovascular events was borderline significant (HR 0.29, 95 % CI 0.08–1.06, p = 0.061). None of the examined biomarkers were associated with new fractures, nor with an increased risk of a new cardiovascular event. ConclusionsAAPR may be a better predictor of mortality than the more novel BTMs, and higher AAPR could be associated with longer life expectancy. Further studies should determine the clinical usefulness of AAPR as a biomarker of mortality and cardiovascular disease.

Femoral Coronal Malalignment is Associated With Failure in Mobile-Bearing Medial Unicompartmental Knee Arthroplasty

BackgroundFemur-first (FF) technique for mobile-bearing medial unicompartmental knee arthroplasty (UKA) has been described as an alternative to tibia-first (TF) technique. The aim of this study was to compare the radiographic results in UKAs using FF or TF techniques and their influence on failure rates. MethodsWe retrospectively reviewed 288 UKAs with a minimum 2-year follow-up. There were 147 knees in the TF and 141 knees in the FF cohorts. Alignment parameters and overhang were assessed as outliers and far outliers. The mean follow-up was 6 years (range, 2 to 16), the mean age was 63 years (range, 27 to 92), and 45% of patients were women. Univariate and multivariate statistical analyses were carried out with Cox regression models. ResultsThere were 13 and 6 revisions in the TF and FF cohorts, respectively. The FF had lower rates of femoral coronal alignment (FCA) or femoral sagittal alignment outliers compared to the TF (5.7% versus 19%, P = .011). Tibial coronal alignment and tibial sagittal alignment did not significantly differ between the techniques (22.7% in FF versus 29.9% in TF, P = .119). Overhang outliers did not differ significantly between the groups. Younger age was associated with a higher revision rate (P = .006), while FF versus TF, sex, body mass index, and postoperative mechanical axis did not show statistically significant associations. In multivariate analysis, FCA outliers and younger age were significantly associated with revision. ConclusionsThe FF technique in mobile-bearing UKA resulted in fewer FCA outliers compared to TF. Despite improved knee alignment with the FF technique, FCA outliers and younger age were associated with a higher revision rate, independent of technique.

Maqin Xiaoke Granule Alleviates Acute Bronchitis Induced by Smoking Combined With Streptococcus pneumoniae by Regulating NLRP3/p38 MAPK/Glycerophospholipid Pathway

Objective: To explore the efficacy and mechanism of action of Maqin Xiaoke Granules (MQs) in the treatment of acute bronchitis (AB). Methods: The rat model of AB was established by mixed smoke and Streptococcus pneumoniae nasal infection. The pathological changes of lung tissue and bronchus were observed by hematoxylin-eosin (HE) staining and scored. The mRNA expression levels of NOD-like receptor thermal protein domain associated protein 3 ( NLRP3) and p38 mitogen-activated protein kinase ( p38 MAPK) in lung tissue were detected by real-time fluorescence quantitative polymerase chain reaction, and the expression levels of inflammatory factors (tumor necrosis factor-α [ TNF-α], interleukin-6 [ IL-6], interleukin-1β [ IL-1β], interleukin-10 [ IL-10]) in serum and lung homogenate were detected by enzyme-linked immunosorbent assay. The therapeutic effect of MQ on rats with AB was preliminarily evaluated. Metabolic profiling of rat serum was performed by ultra high-performance liquid chromatography-quadrupole-time of flight-mass spectrometry/mass spectrometry, combining P &lt; .05, variable important in projection &gt; 1, fold change &gt; 1.5 and screening for differential metabolites based on univariate and multivariate statistical analyses, and then analyzing the possible metabolic pathways with the help of MetaboAnalyst 5.0 database, to analyze the mechanism of MQ’s action on the treatment of AB at the metabolic level. Results: MQ significantly ameliorated the pathological injury of bronchial and lung tissues in model rats, reduced the mRNA levels of NLRP3 and p38 MAPK ( P &lt; .05, .01), lowered the levels of TNF-α, IL-6, and IL-1β in serum and lung homogenates ( P &lt; .05, .01), and elevated IL-10 in serum and lung homogenates ( P &lt; .0001, .01) levels, and to regulate abnormal metabolites in rats with AB via the glycerophospholipid metabolic pathway. Conclusion: MQ significantly improved AB induced by mixed smoke combined with Streptococcus pneumoniae, and the mechanism of its induction may be related to the dysregulation of glycerophospholipid metabolism, and this study provides a reference for the rational clinical application of MQ.